Changing the preschool setting to promote healthy energy balance-related behaviours of preschoolers: a qualitative and quantitative process evaluation of the SuperFIT approach.

Ilona van de Kolk, Sanne Gerards, Anke Verhees, Stef Kremers, Jessica Gubbels
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引用次数: 1

Abstract

Background: The Early Care and Education (ECE) setting plays an important role in the promotion of a healthy lifestyle in young children. SuperFIT is a comprehensive, integrated intervention approach designed to promote healthy energy balance-related behaviours in preschoolers. Insight in the process of implementation and the context in which SuperFIT was implemented supports the understanding of how the intervention works in practice. This process evaluation examined factors that influenced the implementation and maintenance, as well as the (perceived) changes in the ECE setting.

Methods: A mixed-methods study was conducted. SuperFIT was implemented at twelve preschools in the south of the Netherlands. The process evaluation was performed among preschool teachers, managers of the preschool organisation, and implementers. Semi-structured in-depth (group) interviews, quantitative process questionnaires, the Child-care Food and Activity Practices Questionnaire (CFAPQ) and the Environmental and Policy Assessment and Observation (EPAO) were used to evaluate the implementation and maintenance of SuperFIT and the changes in the preschool setting. The interviews were analysed using a theoretical framework based on the Implementation Framework of Fleuren and Damschröder's Consolidated Framework for Implementation Research. Descriptive analyses were performed on the quantitative data.

Results: Various intervention activities were implemented in the preschool setting. Although the intention to maintain SuperFIT was present, this was hindered by time constraints and lack of financial resources. Important factors that influenced implementation and maintenance were incongruence with current practice, limited perceived capabilities to integrate SuperFIT in daily practice, group composition at the preschools, and the perceived top-down implementation. Organizational vision and societal attention regarding healthy behaviour in general were perceived to be supportive for implementation and maintenance. Predominantly, favourable changes were seen in the nutrition- and physical activity-related practices of preschool teachers and other aspects of the social preschool environment such as the use of play materials. Limited changes were observed in the physical preschool environment.

Conclusions: Several factors influenced the implementation and maintenance of SuperFIT in the preschool setting. Some factors evolved over time from hindering to facilitating, emphasising the importance of allowing sufficient time for intervention implementation. SuperFIT changed mainly the social preschool environment.

Trial registration: Clinicaltrials.gov, NCT03021980 , date registered: January 16, 2017, prospectively registered.

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改变学前环境以促进学龄前儿童健康的能量平衡相关行为:SuperFIT方法的定性和定量过程评价
背景:早期护理和教育(ECE)环境在促进幼儿健康生活方式方面发挥着重要作用。SuperFIT是一种全面的综合干预方法,旨在促进学龄前儿童健康的能量平衡相关行为。对实施过程和SuperFIT实施环境的深入了解有助于理解干预措施在实践中是如何起作用的。这一进程评价审查了影响执行和维持的因素,以及欧洲经委会环境中的(可察觉的)变化。方法:采用混合方法进行研究。SuperFIT在荷兰南部的12所幼儿园实施。过程评价是在幼儿园教师、幼儿园组织管理者和实施人员之间进行的。采用半结构化深度(小组)访谈、定量过程问卷、儿童保育食品与活动实践问卷(CFAPQ)和环境与政策评估与观察(EPAO)来评估SuperFIT的实施和维持以及学龄前环境的变化。使用基于Fleuren实施框架和Damschröder实施研究综合框架的理论框架对访谈进行分析。对定量数据进行描述性分析。结果:在幼儿园实施了多种干预活动。尽管有维持SuperFIT的意图,但由于时间限制和缺乏财政资源,这一计划受到了阻碍。影响实施和维持的重要因素是与当前实践不一致,在日常实践中整合SuperFIT的感知能力有限,幼儿园的小组组成,以及感知自上而下的实施。一般认为,组织对健康行为的看法和社会对健康行为的关注有助于实施和维持健康行为。在学前教师的营养和体育活动相关实践以及学前社会环境的其他方面,如游戏材料的使用,都出现了显著的有利变化。幼儿物理环境变化有限。结论:影响SuperFIT在学龄前儿童实施和维持的因素有多种。随着时间的推移,一些因素从阻碍转变为促进,强调了为实施干预留出足够时间的重要性。SuperFIT改变的主要是学前社会环境。试验注册:Clinicaltrials.gov, NCT03021980,注册日期:2017年1月16日,预期注册。
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